Overview

Marasmus (mar-as-mus) is a severe form of malnutrition that particularly affects infants and young children. It is caused by a very low calorie intake which leads to extreme weight loss and muscle wasting. Marasmus is associated with high mortality rates and long-term health issues. In this article, we will look at the causes, symptoms, diagnosis, complications, treatment and prevention of marasmus and its impact on infants and young children.

What is marasmus?

Marasmus is a severe form of malnutrition that mainly occurs in infants and young children. It is caused by a significant reduction in calorie intake. It can lead to extreme weight loss and muscle wasting with associated health consequences and death.¹ 

Who does marasmus affect?

Marasmus can affect anyone with poor nutritional intake. Children and infants are particularly affected as they require more calories to support their growth. 

Marasmus is more common in developing countries, as malnutrition more commonly occurs against a background of poverty, food scarcity, parasites and infectious diseases. 

In the developed world, elderly people in nursing homes and hospitals or who live alone with few resources are more at risk.¹ 

Causes of marasmus

The following are the most common causes of marasmus:

• Marasmus is caused by a prolonged lack of adequate caloric and nutritional intake. This occurs as a result of insufficient food supply due to issues like poverty, food insecurity and natural disasters. 
• Infectious diseases can also contribute to the development of marasmus. In less developed countries where parasites thrive and water supplies may be unsanitised, diarrhoeal diseases are common and can cause malabsorption of nutrients which leads to malnutrition. 
• AIDS compromises the immune system and increases susceptibility to infections that can cause or worsen malnutrition.²
• Eating disorders.¹

Why are infants so susceptible to marasmus?

Maternal health and nutrition are vital to infant health. Poor maternal nutrition during pregnancy can lead to low birth weight and increase the risk of marasmus. Inadequate breastfeeding practices such as early weaning or lack of exclusive breastfeeding can also contribute to the development of marasmus. Human breast milk is considered the optimum source of nutrition for infants due to its ability to provide complete nutrition and immunity. 

Signs and symptoms of marasmus

There are a number of signs and symptoms of marasmus, which include the following:

• visible muscle wasting - also known as muscle atrophy
• sunken fontanelles in babies
• aged appearance in the face
• fatigue and lack of energy
• behavioural changes
• cognitive delays in infancy, childhood and adolescence
• protruding bones
• loose skin
• severe weight loss
• infection¹

Diagnosis of marasmus

Diagnosing marasmus involves a combination of clinical assessment, anthropometric measurements, and laboratory tests. 

Medical examination

A thorough medical history and physical examination can identify the signs of malnutrition and any underlying causes. Medical professionals will look for visible signs of muscle wasting, such as a sunken appearance of the cheeks and eyes or prominent bones.¹

Anthropometry

Anthropometric measurements are useful for assessing the severity of malnutrition. The weight-for-height ratio is commonly used to determine the degree of wasting. Mid-upper arm circumference, measured by skinfold calipers, is another useful indicator. A mid-upper arm circumference measurement of less than 115mm in children under five years old is a strong predictor of severe malnutrition.

Laboratory tests

Laboratory tests can provide some information on a child’s nutritional status and help identify any complications. Blood tests may show anaemia, electrolyte imbalances, and other deficiencies that require intervention. Albumin levels are also often done as an indicator of nutritional status.⁵

Complications of marasmus

Marasmus can lead to a range of severe complications, many of which are life-threatening. 

Patients become immunocompromised

Marasmus can affect the function of the immune system - this is called nutrition-associated immunodeficiency.² Malnourished children who have weakened immune responses are highly prone to infections. The Centers for Disease Control and Prevention (CDC) have reported that pneumonia, diarrhoea, malaria, measles and AIDs are known to account for more than a half of all deaths worldwide in children under five years of age. These infections can all be fatal in the context of severe malnutrition.² Furthermore, acute gastrointestinal and respiratory infections are some of the most common causes of death in malnourished children.⁶ 

Organ dysfunction

Organ failure or damage is also a serious complication of marasmus. The heart, liver and kidneys are vulnerable to damage from prolonged nutrient deficiencies.  

A condition called refeeding syndrome occurs when nutrients are given too fast to a person who is severely malnourished as with marasmus.  Refeeding too rapidly, particularly with carbohydrates, may precipitate a number of metabolic complications, which may adversely affect the cardiac, respiratory, haematological, hepatic and neuromuscular systems, leading to complications or death.^7,8 

Failure to thrive

Developmental issues are a concern in infants and children with marasmus. Chronic malnutrition in utero and early infancy can cause impaired growth and cognitive damage. These developmental delays can have long-term effects on the child's educational and social outcomes.⁴ 

Treatment of marasmus

Treatment of marasmus requires a number of strategies. Immediate medical intervention is often required to stabilise the child's condition if they have infection as a result of becoming immunocompromised. This intervention is then usually followed by nutritional stabilisation and monitoring.¹ 

Rehydration

Rehydration therapy is commonly required, as the majority of children or infants suffering with marasmus are likely to be dehydrated. Rehydration usually involves the use of oral rehydration solutions or intravenous fluids in severe cases.⁹

Treatment of infection

Infections are treated with antibiotics or antiviral medication to prevent further deterioration in the child or infant’s health.¹

Nutritional rehabilitation 

Nutritional rehabilitation is key to treating marasmus. Therapeutic feeding programmes usespecially formulated foods which are designed to provide high-energy and nutrient-dense foods. These foods are introduced gradually to allow the child's digestive system to adapt. The speed of refeeding must not be too fast in order to avoid refeeding syndrome. The nutritional rehabilitation phase may last from 2 to 6 weeks.¹   

Long-term care and review

Long-term care and monitoring are essential to ensure sustained recovery and to prevent relapse. Regular follow-ups and growth monitoring help track the child's progress and identify any ongoing nutritional needs.¹ 

Prevention of marasmus

Preventing marasmus requires a multidisciplinary approach that addresses the root causes of malnutrition. 

Education

Promoting maternal and infant nutrition is a key strategy to preventing marasmus and other forms of malnutrition. Education on nutrition, diet and breastfeeding for the first six months of life can help improve nutritional outcomes. “Breastfeeding provides essential nutrients and antibodies that protect infants from infections” (WHO, 2020).

Food security

Improving food security is another critical action to prevent malnutrition. Community-based nutrition programmes that provide food supplements and support to vulnerable families can help reduce the risk of malnutrition. Economic support for families may also enhance their ability to access sufficient and nutritious food.¹⁰  

Improved access to healthcare

Enhancing healthcare access is vital for early detection and intervention of marsamus and other forms of malnutrition. Regular health check-ups and vaccination programs can help identify and address nutritional deficiencies and prevent infections. Integrated health and nutrition services that include growth monitoring and nutrition counselling can provide comprehensive support to at-risk children and their families.¹

Global and public health challenges of marasmus

Marasmus and other forms of malnutrition, such as Kwashiorkor, remain a major public health challenge, particularly in underdeveloped countries. The prevalence of marasmus varies widely across regions, with the highest rates observed in sub-Saharan Africa and South Asia. According to the United Nations Children's Fund (UNICEF), “approximately 45 million children under the age of five suffer from wasting, with a substantial proportion experiencing severe wasting which includes marasmus” (UNICEF, 2021).

Organizations such as the World Health Organization (WHO) and UNICEF work with governments and non-governmental organizations to implement nutrition programs and policies. These efforts include promoting breastfeeding, improving maternal and child healthcare and enhancing food security.

Summary

Marasmus is a form of severe malnutrition that can be life-threatening, particularly in infants and young children. Understanding its causes, symptoms, and complications is essential for effective diagnosis and treatment. 

Management includes medical intervention, nutritional rehabilitation and long-term monitoring. 

Preventive measures such as promoting maternal and infant nutrition, improving food security, and enhancing healthcare access, are key to reducing the incidence of marasmus.

Addressing marasmus requires a coordinated global effort between international organizations, governments and communities. Prioritizing the health and nutrition of infants and young children can make significant inroads to eliminating marasmus and improving the overall well-being of future generations.